Effect of gabapentin on postoperative pain and operation complications a randomized placebo controlled trial / Efecto de la gabapentina en el dolor postoperatorio y complicaciones de la operación: un ensayo clínico, aleatorio, controlado con placebo

OBJECTIVE: Prevention and treatment ofpostoperative pain and operation complications such as nausea and vomiting are most important concerns in postoperative care. There are several mechanisms involved in postoperative pain. Gabapentin is a gamma aminobutyric acid analogue that is known as an anticonvulsant drug. This drug is tolerated well and has known effects on pain and anxiety. This study has compared the effect of gabapentin on postoperative pain, operation complications and haemodynamics. SUBJECTS AND METHODS: This randomized double blinded placebo controlled clinical trial was conducted on 61 patients divided randomly into two groups (30 as cases and 31 as controls). All patients had total abdominal hysterectomy. In the first group, the patients got 100 mg gabapentin in the night and 300 mg gabapentin orally (one capsule) two hours before surgery. The second group got one capsule of multivitamin orally. Then all patients were subjected to the same anaesthesia protocol and total abdominal hysterectomy. During the 24 hours after operation, the patients were assessed according to pain, nausea, vomiting, dizziness, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR) and morphine use at 1, 6, 12 and 24 hours. RESULTS: Mean age and weight of patients were 45.86 ± 4.06, 48.16 ± 4.48, 64.56 ± 13.29 and 68.8 ± 12.88 in the study population and control groups, respectively. Except in the first hour after operation (p = 0.02), there was no significant differences between the two groups in morphine use. There was no significant correlation between the groups according to postoperative complications and the haemo-dynamic parameters (PR, SBP and DBP). CONCLUSION: Results show that gabapentin can decrease the need for morphine use in the first hour after operation only and has no significant effect on operation complications. Thus, we suggest gabapentin for pain management, and not to decrease opium use.

OBJETIVO: La prevención y tratamiento de dolor postoperatorio y las complicaciones de la operación -tales como la náusea y el vómito - son problemas de suma importancia en el cuidado postoperatorio. Hay varios mecanismos implicados en el dolor postoperatorio. La gabapentina es un análogo del ácido gamma-aminobutírico, conocido como un medicamento anticonvulsivo. Este medicamento es bien tolerado, y tiene efectos conocidos sobre el dolor y la ansiedad. El presente estudio compara el efecto de la gabapentina sobre el dolor postoperatorio, las complicaciones de la operación, y la hemo-dinámica. SUJETOS Y MÉTODOS: Este ensayo clínico, aleatorio, doble ciego y controlado con placebo, se llevó a cabo con 61 pacientes divididos aleatoriamente en dos grupos (30 como casos y 31 como control). Todas las pacientes tuvieron histerectomia abdominal total. En el primer grupo, las pacientes recibieron via oral 100 mg de gabapentina por la noche y 300 mg de gabapentina (una cápsula) dos horas antes de la cirugía. El segundo grupo recibió una cápsula de multivitaminas por vía oral. Luego, todas las pacientes fueron sometidas al mismo protocolo de anestesia e histerectomía abdominal total. Durante las 24 horas después de la operación, las pacientes fueron evaluadas en relación con dolores, náusea, vómitos, vértigo, presión sanguínea sistólica (PSS), presión sanguínea diastólica (PSD), frecuencia de pulso (FP), y el uso de morfina a la 1, 6, 12 y 24 horas. RESULTADOS: La edad promedio y el peso de las pacientes fue 45.86 ± 4.06, 48.16 ± 4.48, 64.56 ± 13.29 y 68.8 ± 12.88 en la población de estudio y los grupos de control, respectivamente. Excepto en la primera hora tras la operación (p = 0.02), no hubo ninguna diferencia significativa entre los dos grupos en cuanto al uso de morfina. No hubo correlación significativa alguna entre los grupos sobre la base de las complicaciones postoperatorias y los parámetros hemodinámicos (FP, PSS, y PSD). CONCLUSIÓN: Los resultados muestran que la gabapentina sólo puede disminuir la necesidad del uso de morfina en la primera hora tras la operación, y no tiene efectos significativos en las complicaciones de la operación. Por lo tanto, se sugiere el uso de la gabapentina para el tratamiento del dolor, pero no para reducir el uso del opio.

Report of two brain cancer cases with survey more than 15 years

Brain tumors are considered in regarded to their size, position and aggressive manner. Brain tumors cause several neurologic symptoms. For instance, they increase intracranial pressure due to local damage and displacement of surrounding tissues. In this paper, two glioblastoma multiform cases with more than 15 year- survival have been reported. The first patient was a 52 year- old woman who suffered from seizure. The CT scan demonstrated a focal low density in the left temporoparietal lobe, and Carbamazepine was prescribed. However, after 12 years, the patient started to suffer from seizures with transient awareness repletion and vomiting. Therefore, daily injection of 16 mg of dexamethason in two divided dosages was prescribed. Fourteen years after illness, biopsy with stereotaxy method was used and glioblastoma multiform was diagnosed by a pathologist. Unfortunately, this patient died due to progression of her illness 16 years after beginning of the seizures. The second patient was a 47 year- old man who also suffered from seizure. In the CT scan, a low density lesion was observed in his left parietal lobe. The patient was treated with 400 mg of Carbamazepine per day in two divided dosages. Dosage of drug was increased to 1200 mg per day. After one year, due to drug resistance, Phenytoin and Phenobarbital were also added to Carbamazepine because of repeated seizures. After 15 years, the soberness disorder of the patient increased and CT scan was repeated. However, due to increase in the tumor size, hydrocephaly surgery was performed and the pathologist reported glioblastoma multiform. Following the surgery, radiotherapy and chemotherapy were also used. This patient is in a good condition now and he has no serious problems. Glioblastoma multiform is a high degree astrocytic tumor. In this paper, two patients who were afflicted with glioblastoma multiform in fourth and fifth decades of their life were presented. The life span of these patients is considerable in contrast to several articles which indicated that a- five -year life span is rare in patients with glioblastoma multiform

Evaluation of an interferon-gamma release assay in young contacts of active tuberculosis cases

In a cross-sectional study in a hospital in Tehran in 2006-08 the QuantiFERON[Registered]-TB interferon-gamma release assay [QTB] was compared with the tuberculin skin test [TST] in 59 young people [aged<20 years] with close contact with immunocompetent cases of proven pulmonary tuberculosis. After 1 year follow-up 10 subjects had progressed to tuberculosis disease and received treatment; TST was positive in 30% and QTB in 100%. Of the 49 non-progressive subjects, TST was positive in 10.4% and QTB in 16.3%. The agreement between TST and QTB assay in non-progressive subjects was poor [Kappa=0.43]. False positive and false negative rates for TST were 40.0% and 9.3% respectively; positive and predictive values were 60.0% and 90.7%. We suggest adding the interferon assay to the skin test in the decision to perform chest X-ray or to start chemoprophylaxis at least in younger subjects [aged<20 years]

Viral infections detected by serology and PCR of perilymphatic fluid in children with idiopathic sensorineural hearing loss

The etiology of sensorineural hearing loss [SNHL] in children may be viral. This cross-sectional study aimed to determine the role of viral infectious agents in children with idiopathic SNHL Of 119 children with SNHL aged 3-168 months undergoing cochlear implant surgery at a hospital in Tehran, no cause could be established in 18 cases [15.1%]. Cytomegalovirus [CMV] and herpes simplex virus [HSV] active infections [detected by DNA-PCR, confirmed by serology] were found in the perilymphatic fluid of 16.7% [3/18] cases of idiopathic SNHL Serology was performed on blood samples from 11 of these cases: specific antibodies against CMV, Toxoplasmo spp., HSV and rubella were determined in all cases; acute T. gondii infection was detected in 7 cases and rubella IgG was found in only 1 case. Neonatal screening for CMV, HSV and T. gondii may be helpful in the Islamic Republic of Iran

Prevalence of nosocomial urinary tract infection in PICU of referral children hospital in Iran

To determine the prevalence of the occurrence, risk factors and microbiology for acquiring UTIs in the PICU of one of the main referral children hospital in Iran. A surveillance study was conducted among all children admitted to PICU in the Mofid children hospital in Tehran between July 2007 and July 2008. During the one year, 428 patients were admitted to PICU for 48 hours or more and a total of 31 [7.2%] acquired UTIs, yielding an overall incidence density, of 11 per 1000 PICU days. One bacteremic [4.3%] ICU-acquired UTIs occurred. Mean hospital staying in UTI patients was 22 days comparing with 7 days in other patients [P value<0.001] but mortality rate difference was not significant [P value=0.2]. The most common organisms isolated were Escherichia coli [30.4%], Kelebsiellapneumoniae[30.4%] and Candida a/b/cans[21.7%]. Monitoring of a PICU-acquired UTI is important in critically ill patients. The results of this study offer a reliable measure of the prevalence of nosocomial UTIs at hospitals in Iran and provide a baseline for future studies

Immunoasssay chromatographic antigen test for rapid diagnosis of Group A beta hemolytic Streptococcus pharyngitis in children: a cross/ sectional study

Group A beta-hemolytic streptococcus [GABHS] is an important pharyngotonsillitis etiologic agent in children. The objective of this study was diagnosis of streptococcal pharyngitis based on rapid antigen detection test and conventional pharyngeal culture. The rapid GABHS antigen detection test was compared to culture on blood agar, the gold standard for the diagnosis of this etiologic agent. Streptococcal antigen was detected in pharyngeal specimens of 34.5% of cases by rapid strip test. We detected group A Streptococcus in 17.2% of pharyngeal culture. There was no agreement between two methods [PV < 0.1]. The negative pharyngeal culture results are probably due to antibiotic usage in 43.2% of patients. Positive rapid test results in pharyngeal swab was age dependent [P < 0.05]. There was good correlation between observing the [petechia in pharynx of patients] and positive rapid test in pharyngeal swab [P < 0.004]. Throat culture results were relatated to previous antibiotic usage [P < 0.03]. The rapid test in pharyngeal swab is helpful for rapid diagnosis and treatment of GABHS pharyngitis. Diagnosis of GABHS pharyngitis based on soley clinical findings is misleading in the majority of cases. Petechia observed in pharynx of the cases was highly predictive of streptococcal pharyngitis

Cast immobilization for treatment of dorsally subluxated proximal interphalangeal joint in a Thoroughbred mare

Subluxation of the proximal interphalangeal joint [PIPJ or pastern joint] is an uncommon condition that occurs in the forelimb or hindlimb. Thoroughbred racehorses rarely show dorsal pastern subluxation [Thoroughbred ringbone] secondarily to an injury to the soft tissues supporting the fetlock. A 4-year-old Thoroughbred mare was presented with signs of lameness, swelling of the dorsal aspect of the pastern region of the right forearm and audible clicking sound when weight was placed on the limb. The condition seemed to have been developed as a consequence of extreme overexertion 4 days before referral. Radiographic examination of a non-weight bearing limb showed dorsal subluxation of the pastern joint. Under general anesthesia the affected limb was immobilized by cast after reduction of the luxated bone into the PIPJ. The affected limb was kept immobilized for four weeks. Then the cast was removed and the animal was given rest for two months. Consequently, weight bearing on the affected limb was improved and no signs of lameness were observed after six months

[Nd:YAG membranotomy in diabetic premacular hemorrhage]

To evaluate the success rate of Nd:YAG laser membranotomy in patients with diabetic premacular hemorrhage. This interventional case series included 24 eyes of 22 patients referred to retina clinic of Farabi Eye Hospital, Tehran, Iran during 2000-2007 with chief complaint of sudden loss of vision and clinical diagnosis of premacular hemorrhage due to proliferative diabetic retinopathy. All patients underwent complete ocular examination and color fundus photography. Nd:YAG laser membranotomy was performed in patients with >3 DD hemorrhage. Main outcome measures were success rate of membranotomy, improvement of visual acuity and the complications. Twenty-four eyes of 22 patients [68.2% female and 31.8% male] with diabetic premacular hemorrhage were enrolled. Mean age of patients was 56 +/- 6.5 years. Nd:YAG laser membranotomy was successful in 71% of patients resulting in release of trapped blood into the vitreous cavity which absorbed during 14.3 +/- 5.03 [range 8 to 27] days. Range of preoperative visual acuity was from hand motion to count finger at 4 m which improved to a range of 20/100 to 20/25 postoperatively. Patients complained of some visual disorders such as blurred vision and floater over 23-86 days [mean 43 days], postoperatively. Macular photocoagulation was performed in 11 eyes with macular edema before panretinal photocoagulation. Mean follow-up period was 34.7 +/- 18.3 [range 10-71] months. Nd:YAG laser membranotomy in diabetic premacular hemorrhage is a simple and inexpensive outpatient procedure which results in rapid visual recovery and is relatively safe. Further controlled clinical trials are recommended

[Prevalence and risk factors for gestational diabetes mellitus in pregnant women of Isfahan, Iran]

There are limited studies concerning the prevalence of gestational diabetes [GDM] in Iran. This study was performed to investigate the prevalence and risk factors for GDM in Isfahan, and to compare the results of selective and universal GDM screening methods. In a cross - sectional study conducted between June 2003 and March 2005, GDM universal screening [based on the Carpenter and Coustan criteria] was done for pregnant women between 24 and 28 weeks of gestation, referred to the Isfahan Endocrine and Metabolism Research Center; 1112 pregnant women with no history of diabetes underwent 50 gr glucose challenge test [GCT]. Cases with blood sugar >/= 130 mg/dL were considered positive and underwent a 3-hour, 100 gr glucose tolerance test [OGTT]; this was also done randomly in some of negative GCT cases. OGTT was performed in 245 GCT - positive cases and 130 women with negative G.C.T, GDM was diagnosed in 67 and 6 women respectively, showing a total prevalence of 6.76% for GDM. Of all pregnant women, 23.2% were classified as a low-risk group, including only 2 diagnosed cases of GDM [2.7% of all GDM cases]. Among risk factors, only age, pre-pregnancy BMI and gravidity were significantly correlated with GDM. There is a moderate prevalence of GDM in Isfahan; a selective GDM screening method seems to be more appropriate for this community

[Iohexol effects on tear biochemical profiles in normal large animal model]

Dacryocystography or visualization of nasolacrimal duct has been widely used in the assessment of the nasal lacrimal system. The water-soluble agent iohexol is currently widely used in nervous and vascular lesion in diagnostic radiology and also employed in dacryocystography. This study was performed to determine the effects of iohexol on tear parameters in normal donkey as a large animal model. We examined 10 normal donkeys mean age approximately 4.5 years. The donkeys received iohexol once a day. All donkeys were housed out doors throughout the study. Different tear parameters [total protein, lysozyme, sodium, and potassium and protein electrophoresis of tear] were measured at 0, 2 hours and 2 weeks after dacryocystography with iohexol. The results showed that mean and standard deviation of total protein of tear were 5.88 +/- 2.15 mg/ml before dacryocystography and after 2 hours was 4.10 +/- 0.96 and after two weeks was 7.36 +/- 3.68. Mean and standard deviation of lysozyme was 858.39 +/- 170.88 units in Mg of protein of tear and after two hours was 1013.19 +/- 178.67 and after two week was 702.54 +/- 360.50. Mean +/- SD of sodium of tear before dacryocystography was 3084.90 +/- 725.44 micro/ml and after two hours and two weeks were 3508.40 +/- 1372.52 and 8026.20 +/- 2953.88 respectively. Mean +/- SD of Potassium of tear before dacryocystography was 863.37 +/- 52.55 micro/ml and after two hours and two weeks were 753.84 +/- 46.81 and 1564.20 +/- 276 +/- 41 respectively. Results of SDS-PAGE of donkeys tear confirmed that nine protein bands with molecular weights between 10 kDa and 15 kDa are present. No differences found in protein electrophoresis pattern before and after iohexol administration. No significant changes were present in measured factors at different times. In conclusion iohexol is a safe and suitable contrast media for dacryocystography

[Intravitreal triamcinolone for treatment of refractory diabetic macular edema]

To determine if intravitreal injection of triamcinolone acetonide is safe and effective in the treatment of diabetic macular edema unresponsive to prior laser photocoagulation. Fifty-four eyes of 38 patients with clinically significant macular edema which had received at least two sessions of laser photocoagulation according to Early Treatment Diabetic Retinopathy Study guidelines were enrolled in this study. At least four months after laser therapy; eyes with residual central macular thickness [CMT] greater than 250 microm on optical coherence tomography [OCT] and visual loss from baseline were offered intravitreal injection of 4 mg triamcinolone acetonide. Visual and anatomic responses as well as complications related to the injection procedure and corticosteroid medication were observed. Mean baseline best corrected visual acuity [BCVA] and CMT were 0.77 +/- 0.5 LogMAR and 443 +/- 138 microm, respectively. All patients completed one month of follow up and 39 of 54 eyes [72.2%] completed 6 months of follow up. Mean BCVA was 0.64 +/- 0.45, 0.56 +/- 0.48, and 0.79 +/- 0.55 LogMAR at months 1, 3, and 6, respectively. Central macular thickness measured by OCT decreased by 39% and 23.5%, at the third and sixth month visits, respectively. Intraocular pressure exceeded 21 mmHg in 36.3% of the eyes. Cataract progression was noted in 12.8% of phakic eyes. Intravitreal triamcinolone seems a promising therapeutic method for diabetic macular edema refractory to conventional laser photocoagulation without any significant complication, however the effect seems to be temporary. Further studies are warranted to assess the long-term efficacy and safety and also the need for retreatment

[Prevalence and risk factors of retinopathy of prematurity in very low birth weight or low gestational age infants]

To determine the incidence of retinopathy of prematurity [ROP] and to evaluate the possible neonatal risk factors for ROP. This cross-sectional study included all premature infants born at hospitals affiliated to Tehran Medical University, Tehran-Iran who were referred within 4-6 weeks after delivery to Farabi Eye Hospital from 2004 to 2005. Inclusion criteria were birth weight [BW] < 1500 g or gestational age [GA] 32 wk who may be at high risk for ROP should also be screened

Nasal chondromesenchymal hamartoma in an adolescent: a report of case and review of literature

Nasal chondromesenchymal hamartoma [NCMH] is an extremely uncommon primary benign cartilaginous growth of the nasal and paranasal sinuses. It has been reported almost exclusively in infancy. We report a NCMH in a 23-year-old patient who presented with anosmia, right gaze diplopia and proptosis. CT scan of paranasal sinuses revealed frontal sinus mass extending to the right orbit, ethmoid cells and nose. After an initial inconclusive incisional biopsy, the patient underwent a complete radical resection; and the defect was reconstructed with osteoplastic flap of frontal sinus. Histopathological examination confirmed NCMH, which, we believe, probably had been present and undetected for many years. This report greatly extends the age of NCMH, as part of the differential diagnosis of cartilaginous lesions of the nose and paranasal sinuses

Clinical and biomechanical effects of morphine on skin wound healing

Opioids analgesics are used as premedication and in maintenance of anesthesia and in post-operative pain control. 20 female rabbits were assigned to experimental and control groups and followed for healing process for 20 days. Each rabbit was anesthetized, and a full-thickness skin incision, 3 cm long, was made on its back. The wounds were closed with non-absorbable suture. Morphine and saline were administered to experimental and control groups, respectively. The rate of wound healing was similar in both groups. While tensile strength of normal intact skin was significantly [P<0.05] higher than that of both groups, it was not different between the study and control groups. Collagen content and its maturity may be responsible for this observation

Prevalence and types of urinary calculi in male sheep in Fars province, southern Iran

Considering that most urinary calculi in ruminants are formed in sigmoid flexure, urethral process and urinary bladder, these organs were collected from slaughtered male sheep from Fars Meat Complex The first step was to take a radiograph. All parts of the penile urethra and urinary bladder were then palpated for possible presence of calculi. Finally, the urethra and urinary bladder were opened using a surgical blade. Out of 600 specimens, only two [0.3%] had urolithiasis: one of them was in the urethral process and the other one was in the sigmoid flexure. The two cases were from flocks grazing ranges located in the north of the province where the climate is cold and animals are mainly fed on concentrates. They were both rams: one was 2.5 and the other 4-year-old. The composition of one calculus was struvite [MgNH[4]PO[4].6H[2]O] and the other was made of apatite [calcium phosphate, Ca[3] [PO[4]][2]

[Application of polymerase chain reaction to confirm mycobacterium infection in goat]

Evaluation of PCR test to confirm the samples that showed mycobacterium infection.Observational study.One thousand goats, lymph nodes and organs with visible lesion in reactor goats. At first the goats were tested by CIDT method. Measuring thikness of skin, clinical and necropsy examination in reactor and suspicious goats.Sampling of organs with visible lesion. Bacteriologic test and PCR by [Hot start PCR] kit. The type of primer used in study was IS116. In all goats which were studied, 7 goats responded positive and 4 suspicious. In 11 goats under study, 4 show mycobacterium tuberculosis complex by PCR test.those result were compare with result of bacteriology tests. Not only this study is the first research about mycobacterium in goat in Iran, but also is the first research to confirm mycobacterium tuberculosis complex infection in small ruminant and evaluation PCR test for diagnosis mycobacterium in samples

[Radiological, clinical and paraclinical study of iohexol in myelography of the dog]

Myelography and analysis of cerebrospinal fluid are frequently required for the diagnosis of central nervous system diseases. Residual effects of radiographic contrast media may alter interpretation of the C.S.F if a sample is analyzed shortly after myelography. Iohexol is a water - soluble, nonionic radiographic contrast medium that has widespread acceptance in myelography. In the present study the effects of iohexol myelography and repeated cisternal puncture in the dog were studied. Ten clinically normal mixed breed dogs prepared for aseptic puncture of the cisterna cerebello medullaris. Samples were collected for cytologic and chemical analysis. Blood samples for a hemogram were also collected at this time. Six dogs then received an intracisternal injection of a sterile solution of iohexol [omnipaque], 0.45 ml/kg body weight. C.S.F. was obtained from the four control dogs, but they received no iohexol. By the same aseptic technique C.S.F. was obtained form each dog 24 hours after injection for cytologic and chemical analysis. Blood samples were also collected at this time. Factors of total protein, glucose, creatine phosphokinase, physical specifications, cell count and differentiation of C.S.F from both groups before and 24 hours after the injection of contrast media were determined. Other factors like hematocrite, total protein glucose, red and white cell count of serum and peripheral blood of animals before and 24 hours post injection of contrast media were determined as well. The animals were followed up for 27 hours all the changes in temperature, respiration and heart rate during these hours and the anesthetic condition in two steps of examination were not significant and there was no any seizeures, The mean of total protein concentration in C.S.F of the test group, after 24 hours of myelography, was increased significantly [p<0.05]. The mean of total cell count, red and white cell count in the C.S.F of the test group 24 hours after the myelography showed a significant increase [p<0.01]. No significant changes were found for any other parameter. The myelographs had an appropriate quality